Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/35—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom
  • A61K31/351—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom not condensed with another ring
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D405/00—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom
  • C07D405/02—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings
  • C07D405/12—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings linked by a chain containing hetero atoms as chain links
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/365—Lactones
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/4353—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/436—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a six-membered ring having oxygen as a ring hetero atom, e.g. rapamycin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/12—Drugs for disorders of the urinary system of the kidneys
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P19/00—Drugs for skeletal disorders
  • A61P19/04—Drugs for skeletal disorders for non-specific disorders of the connective tissue
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D405/00—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom
  • C07D405/02—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings
  • C07D405/10—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings linked by a carbon chain containing aromatic rings
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D498/00—Heterocyclic compounds containing in the condensed system at least one hetero ring having nitrogen and oxygen atoms as the only ring hetero atoms
  • C07D498/12—Heterocyclic compounds containing in the condensed system at least one hetero ring having nitrogen and oxygen atoms as the only ring hetero atoms in which the condensed system contains three hetero rings
  • C07D498/16—Peri-condensed systems

Definitions

• the present application relates to methods for treating and preventing neurocutaneous disorders, such as mediated via the Tuberous Sclerosis Complex (TSC), e.g. tuberous sclerosis and such as mediated via neurofibromatosis type 1.
• TSC Tuberous Sclerosis Complex
• Neurocutaneous disorders as used herein includes disorders mediated via the Tuberous Sclerosis Complex (TSC), e.g. tuberous sclerosis and related disorders and neurofibromatosis type 1 and related disorders.
• TSC Tuberous Sclerosis Complex
• NF1 neurofibromatosis type 1
• TSC tuberous sclerosis complex
• TSC is an autosomal dominant disorder characterized by widespread benign hamartomas, epilepsy, mental retardation, and autism. TSC is linked to mutations in the tumor suppressor genes, TSC1 and TSC2. Mutation in either of these two genes leads to the clinical manifestations of TSC. Common clinical symptoms include seizures, mental retardation, autism, kidney failure, facial angiofibromas and cardial Rhabdomyomas, and, in addition, many affected individuals have cyst-like areas within certain skeletal regions, particularly bones of the fingers and toes (phalanges). Characteristic skin lesions include sharply defined areas of decreased skin coloration (hypopigmentation) that may develop during infancy and relatively small reddish nodules that may appear on the cheeks and nose beginning at approximately age four.
• reddish lesions eventually enlarge, blend together (coalesce), and develop a wart-like appearance (sebaceous adenomas). Additional skin lesions may also develop, including flat,"coffee- colored”areas of increased skin pigmentation(cafe-au-lait spots); benign, fibrous nodules (fibromas) arising around or beneath the nails; or rough, elevated, "knobby”lesions (shagreen patches) on the lower back.
• AMLs renal angiomyolipomas
• AMLs are heterogeneous, benign tumors composed of three distinct cell types including smooth muscle, blood vessel, and adipose cells.
• TSC patients also present with evidence of a devastating form of lung disease called Lymphangioleiomyomatosis (LAM).
• LAM Lymphangioleiomyomatosis
• LAM is a unique and rare cystic pulmonary disease (lung) disease that afflicts predominately premenopausal women. Over time, the muscle cells block the flow of air, blood, and lymph to and from the lungs, preventing the lungs from providing oxygen to the rest of the body.
• Kidney tumors that are often asymptomatic may also be found in patients with LAM, e.g. clinical symptoms are dysapnea, chronic cough, wheezing, pneumothorax, and chest pain,. These symptoms occur and worsen as LAM cells migrate into the lung, causing cystic parenchymal destruction and progressive respiratory failure.
• LAM can occur as an independent condition (sporadic LAM) or as a secondary condition of TSC (TSC-LAM).
• AMLs are symptomatic of both LAM (50% of patients presenting) and TSC (70% of patients presenting), and there are no radiological, morphological or genetic differences between AMLs from the two disorder.
• tuberous sclerosis gene mutations are a cause of lymphyangioleiomyomatosis (LAM).
• LAM lymphyangioleiomyomatosis
• the mutations were found in the angiomyolipoma cells and LAM cells from four women with LAM. The mutations were not present in normal lung, kidney or blood cells, indicating that these women with LAM do not have the inherited disease, tuberous sclerosis. Identifying this genetic link between tuberous sclerosis and sporadic LAM is an important step in LAM research, (see e.g. "Mutations in the tuberous sclerosis complex gene TSC2 are a cause of sporatic lymphyangioleiomyomatosis"; Carsillo, Astrinidis and Henske; PNAS 2000 97:6085-90).
• SEGAs subependymal giant cell astrocytomas
• Neurofibromatosis type 1 (NF1 , von Recklinghaus disease) is one of the most common genetic disorders in man. NF1 is caused by a mutation in the NFL gene. NF1 affects the skin, brain, eyes, kidneys and many other parts of the body. NF1 is characterized by developmental changes in the nervous system, muscles, bones and skin, with formation of neurofibromas (benign and malignant tumors/lumps) over the entire body, particularly in the skin and brain: Manifestations of NF1 include formation of neurofibromas (benign and malignant tumors/lumps, gliomas, e.g.
• optical pathway gliomas such as low grade gliomas over the entire body, particularly in the skin, brain, optical pathway, bone, hyperpigmentated areas of skin, e.g. patches of pigmentation (coffee coloured birthmarks) called f cafe-au-lait' spots, bone diseases, learning disabilities, myeloid malignancies, high blood pressure, and other complications in several organ systems. Scoliosis (curvature of the spine) may also be associated.
• Gliomas primary brain tumors start in the brain or spinal cord tissue. They do not spread to other areas of the body but can spread within the nervous system. Gliomas can be either benign (slow growing) or malignant (fast growing). Types of gliomas e.g. include - astrocytomas, which start in brain cells called astrocytes and can occur in most parts of the brain (and occasionally in the spinal cord; they are most commonly found in the main part of the brain, the cerebrum;
• cerebrospinal fluid a rare glioma and can be found anywhere in the brain or spine, but most commonly in the main part of the brain, the cerebrum:
• - oligodendrogliomas which are primary brain tumors beginning in the brain cells called oligodendrocytes, which provide support and nourishment for the cells that transmit nerve impulses.
• This tumor is normally found in the cerebrum;
• - mixed gliomas which are brain tumors of more than one type of brain cell, including cells of astrocytes, ependymal cells and/or oligodendrocytes.
• the most common site for a mixed glioma is the cerebrum, the main part of the brain. Like other gliomas, they may spread to other parts of the brain. Low grade gliomas are slow growing.High grade (malignant) gliomas grow much more quickly.
• Grad IV gliomas are designated glioblastomas,
• Neurofibromatosis also includes the malignant peripheral nerve sheath tumor (MPNST) (manifestations are also designated as neurofibromas and schwannomas) which is the malignant counterpart to benign soft tissue tumors.
• MPNST peripheral nerve sheath tumor
• neurofibromatosis eg. type NF1
• rapamycin derivatives have been found to be effective in tuberous sclerosis and NF-1 models and such compounds are prone for the treatment of neurocutaneous disorders in which affected individuals develop tumors at an increased frequency, such as tuberous sclerosis and neurofibromatosis type 1 , including related disorders.
• the present invention provides 1.1 A compound of formula e.g. including a compound of formula
• R 2 is H, -CH 2 -CH 2 -OH or -CHz-CHz-CHC ⁇ alkyl, e.g. -CH 2 -CH 2 -O-CH 2 -CH 3 , and
• the present invention further provides 1.2a A compound of formula I wherein R 1 , R 2 and X are as defined above, the compound ABT578, or the compound TAFA-93, for use in the treatment of disorders mediated via the Tuberous Sclerosis Complex, for inducing regression of disorders mediated via the Tuberous Sclerosis Complex, for treating symptoms associated with disorders mediated via the Tuberous Sclerosis Complex, for the treatment of disorders associated with disorders mediated via the
• Tuberous Sclerosis Complex and/or for inhibiting or controlling disorders mediated via the Tuberous Sclerosis Complex, e.g. wherein disorders mediated via the Tuberous Sclerosis Complex include tuberous sclerosis, renal angiomyolipomas (ALM), lymphangioleiomyomatosis (LAM), subependymal, and/or giant cell astrocytomas (SEGAs).
• disorders mediated via the Tuberous Sclerosis Complex include tuberous sclerosis, renal angiomyolipomas (ALM), lymphangioleiomyomatosis (LAM), subependymal, and/or giant cell astrocytomas (SEGAs).
• ALM renal angiomyolipomas
• LAM lymphangioleiomyomatosis
• SEGAs giant cell astrocytomas
• 1.2b A compound of formula I wherein R 1 , R 2 and X are as defined above, or the compound ABT578, the compound CCI779, the compound AP23573 or the compound TAFA-93, for the treatment of neurofibromatosis type 1 (NF1), for inducing regression of disorders mediated via NF1 , for treating symptoms associated with NF1 , and/or for inhibiting or controlling disorders mediated via NF1.
• NF1 neurofibromatosis type 1
• Preferred compounds of formula I include
• 16-pent-2- ynyloxy-32 (S orR)-dihydro-40-O-(2-hydroxyethyl)-rapamycin such as 40-O-(2-hydroxyethyl)-rapamycin and/or 32-deoxorapamycin, e.g. 40-O-(2-hydroxyethyl)-rapamycin which is also known under the name everolimus.
• the compounds ABT578, TAFA-93 and a compound of formula I wherein R 1 , R 2 and X are as defined above, are also designated herein as "TSC-compound(s) of (according to) the present invention”.
• the compounds ABT578, CCI779, AP223573, TAFA-93 and a compound of formula I wherein R 1 , R 2 and X are as defined above, are also designated herein as "NF1- compound(s) of (according to) the present invention”.
• the present invention provides 1.3a A method for treating disorders mediated via the Tuberous Sclerosis Complex, comprising administering to a subject in need thereof a therapeutical effective amount of a TSC-compound of the present invention.
• 1.4a A method for inducing regression of disorders mediated via the Tuberous Sclerosis
• TSC-compound of the present invention comprising administering to a subject in need thereof a therapeutical effective amount of a TSC-compound of the present invention.
• 1.5a A method for treating symptoms associated with disorders mediated via the Tuberous Sclerosis Complex, comprising administering to a subject in need thereof a therapeutically effective amount of a TSC-compound of the present invention.
• 1.6a A method for the treatment of disorders associated with disorders mediated via the Tuberous Sclerosis Complex, comprising administering to a subject in need thereof a therapeutically effective amount of a TSC-compound of the present invention.
• 1.7a A method for inhibiting or controlling disorders mediated via the Tuberous Sclerosis Complex, comprising administering to a subject in need thereof a therapeutically effective amount of a TSC-compound of the present invention.
• NF1 neurofibromatosis type 1
• NF1- compound of the present invention 1.3b A method for the treatment of neurofibromatosis type 1 (NF1) disorders, comprising administering to a subject in need thereof a therapeutical effective amount of a NF1- compound of the present invention.
• 1.4b A method for inducing regression of disorders mediated via NF1 , comprising administering to a subject in need thereof a therapeutical effective amount of a NF1- compound of the present invention.
• 1.5b A method for treating symptoms associated with NF1 , comprising administering to a subject in need thereof a therapeutically effective amount of a NF1 -compound of the present invention.
• 1.6b A method for inhibiting or controlling disorders mediated via NF1 , comprising administering to a subject in need thereof a therapeutically effective amount of a NF1- compound of the present invention.
• a compound of the present invention is 40-O-(2-hydroxyethyl)- rapamycin, 32-deoxorapamycin, 16-pent-2-ynyloxy-32-deoxorapamycin, 16-pent-2- ynyloxy-32 (S or R) -dihydro-rapamycin, or 16-pent-2-ynyloxy-32 (S orR)-dihydro-40-0- (2-hydroxyethyl)-rapamycin; such as 40-O-(2-hydroxyethyl)-rapamycin or 32-deoxorapamycin, e.g. 40-O-(2-hydroxyethyl)-rapamycin (e.g. herein also designated as "Compound A").
• the present invention provides
• ALM renal angiomyolipomas
• LAM lymphangioleiomyomatosis
• a TSC-compound of the present invention for use in the manufacture of a medicament for use in any method or use as defined under 1.1, 1.8, 1.2a to 1.7a or 2.1 to 2.4 above, e.g. including preferred aspects as defined above.
• TSC-compound of the present invention for the manufacture of a medicament for use in any method or use as defined under 1.1 , 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above, e.g. including preferred aspects as defined above.
• the present invention provides
• a NF1 -compound of the present invention for use in the manufacture of a medicament for use in any method or use as defined under 1.1 , 1.8 or 1.2b to 1.7b above, e.g. including preferred aspects as defined above.
• Any compound of the present invention e.g. including TSC-compounds and NF1 compounds for use in any method or use as defined under 1.1 , 1.8, 1.2a to 1.7a, 1.2b to 1.6b or 2.1 to 2.4 above, or for the manufacture of a medicament as defined under 3.1a, 3.2a, 3.1b or 3.2b above, e.g. including preferred aspects as defined above, is preferably used in the form of a pharmaceutical composition.
• a pharmaceutical composition comprising a TSC-compound of the present invention in association with at least one pharmaceutically acceptable excipient, e.g. appropriate carrier and/or diluent, e.g. including fillers, binders, disintegrants, flow conditioners, lubricants, sugars or sweeteners, fragrances, preservatives, stabilizers, wetting agents and/or emulsifiers, solubilizers, salts for regulating osmotic pressure and/or buffers; for use in any method or use as defined under 1.1, 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above, e.g. including preferred aspects as defined above. e.g. and for use in the preparation of a medicament as defined under 3.1a and 3.2a above.
• diluent e.g. including fillers, binders, disintegrants, flow conditioners, lubricants, sugars or sweeteners, fragrances, preservatives, stabilizers, wetting agents and/
• a pharmaceutical composition comprising a NF1 -compound of the present invention in association with at least one pharmaceutically acceptable excipient, e.g. appropriate carrier and/or diluent, e.g. including fillers, binders, disintegrants, flow conditioners, lubricants, sugars or sweeteners, fragrances, preservatives, stabilizers, wetting agents and/or emulsifiers, solubilizers, salts for regulating osmotic pressure and/or buffers; for use in any method or use as defined under 1.1 , 1.8, or 1.2b to 1.6b above, e.g. including preferred aspects as defined above. e.g. and for use in the preparation of a medicament as defined under 3.1b and 3.2b above.
• diluent e.g. including fillers, binders, disintegrants, flow conditioners, lubricants, sugars or sweeteners, fragrances, preservatives, stabilizers, wetting agents and/or e
• Any compound of the present invention e.g. including TSC-compounds and NF1- compounds, may be used in any method, for any use and in any pharmaceutical composition as provided by the present invention alone or in combination with one or more, at least one, second drug substance.
• the present invention provides 5.1a A combination of a TSC-compound of the present invention with at least one second drug substance, for any method or use as defined under 1.1, 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above, e.g. including preferred aspects as defined above.
• 5.2a A pharmaceutical combination comprising a compound of the present invention in combination with at least one second drug substance, for any method or use as defined under 1.1, 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above, e.g. including preferred aspects as defined above.
• a pharmaceutical composition comprising a TSC-compound of the present invention in combination with at least one second drug substance and one or more pharmaceutically acceptable excipient(s), for any method or use as defined under 1.1, 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above, e.g. including preferred aspects as defined above.
• TSC-compound of the present invention for the manufacture of a medicament for use in combination with a second drug substance, for use in any method or use as defined under 1.1, 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above, e.g. including preferred aspects as defined above.
• a TSC-compound of the present invention in combination with at least one second drug substance for the manufacture of a medicament for use in any method or use as defined under 1.1, 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above, e.g. including preferred aspects as defined above..
• 5.6a Any method as defined under 1.1, 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above, e.g. including preferred aspects as defined above, comprising co-administering, concomitantly or in sequence, a therapeutically effective amount of a TSC-compound of the present invention and at least one second drug substance, e.g. in the form of a pharmaceutical combination or composition.
• 5.7a A method as defined under 5.6a above, wherein a TSC-compound of the present invention is administered intermittently.
• the present invention provides 5.1b A combination of a NF1-compound of the present invention with at least one second drug substance, for any method or use as defined under 1.1 , 1.8, or 1.2b to 1.6b above, e.g. including preferred aspects as defined above.
• 5.2b A pharmaceutical combination comprising a NF1 -compound of the present invention in combination with at least one second drug substance, for any method or use as defined under 1.1 , 1.8, 1.2b to 1.6b, e.g. including preferred aspects as defined above.
• a pharmaceutical composition comprising a NF1 -compound of the present invention in combination with at least one second drug substance and one or more pharmaceutically acceptable excipient(s), for any method or use as defined under 1.1,
• NF1 -compound of the present invention for the manufacture of a medicament for use in combination with a second drug substance, for use in any method or use as defined under 1.1, 1.8, or 1.2b to 1.6b above, e.g. including preferred aspects as defined above.
• NF1 -compound of the present invention in combination with at least one second drug substance for the manufacture of a medicament for use in any method or use as defined under 1.1 , 1.8, or 1.2b to 1.6b above, e.g. including preferred aspects as defined above.
• 5.6b Any method as defined under 1.1, 1.8, or 1.2b to 1.6b above, e.g. including preferred aspects as defined above, comprising co-administering, concomitantly or in sequence, a therapeutically effective amount of a NF1 -compound of the present invention and at least one second drug substance, e.g. in the form of a pharmaceutical combination or composition.
• 5.7b A method as defined under 5.6b above, wherein a NF1 -compound of the present invention is administered intermittently.
• Combinations include fixed combinations, in which a compound of the present invention, and at least one second drug substance are in the same formulation; kits, in which a compound of the present invention and at least one second drug substance in separate formulations are provided in the same package, e.g. with instruction for co-administration; and free combinations in which a compound of the present invention and at least one second drug substance are packaged separately, but instruction for concomitant or sequential administration are given; e.g wherein a compound of the present invention either is aTSC-compound, or a NF1- compound.
• a pharmaceutical package comprising a first drug substance which is a TSC- compound of the present invention and at least one second drug substance, beside instructions for combined administration;
• a pharmaceutical package comprising a TSC-compound of the present invention beside instructions for combined administration with at least one second drug substance;
• a pharmaceutical package comprising at least one second drug substance beside instructions for combined administration with a TSC-compound of the present invention; for use in any method or use as defined under 1.1 , 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above, e.g. including preferred aspects as defined above.
• a pharmaceutical package comprising a first drug substance which is a NF1- compound of the present invention and at least one second drug substance, beside instructions for combined administration;
• a pharmaceutical package comprising a NF1 -compound of the present invention beside instructions for combined administration with at least one second drug substance;
• a pharmaceutical package comprising at least one second drug substance beside instructions for combined administration with a NF1 -compound of the present invention; for use in any method or use as defined under 1.1 , 1.8, or 1.2b to 1.6b above, e.g. including preferred aspects as defined above.
• Treatment with combinations according to the present invention may provide improvements compared with single treatment.
• the present invention provides
• a pharmaceutical combination comprising an amount of a TSC-compound of the present invention and an amount of a second drug substance, wherein the amounts are appropriate to produce a synergistic therapeutic effect;
• 5.12a A method for improving the therapeutic utility of a TSC-compound of the present invention comprising co-administering, e.g. concomitantly or in sequence, a therapeutically effective amount of a compound of the present invention and a second drug substance.
• 5.13a A method for improving the therapeutic utility of a second drug substance comprising co-administering, e.g. concomitantly or in sequence, a therapeutically effective amount of a TSC-compound of the present invention and a second drug substance. for use in any method or use as defined under 1.1, 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above.
• a pharmaceutical combination comprising an amount of a NF1 -compound of the present invention and an amount of a second drug substance, wherein the amounts are appropriate to produce a synergistic therapeutic effect;
• 5.12b A method for improving the therapeutic utility of a NF1-compound of the present invention comprising co-administering, e.g. concomitantly or in sequence, a therapeutically effective amount of a compound of the present invention and a second drug substance.
• 5.13b A method for improving the therapeutic utility of a second drug substance comprising co-administering, e.g. concomitantly or in sequence, a therapeutically effective amount of a NF1 -compound of the present invention and a second drug substance, for use in any method or use as defined under 1.1, 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above.
• a pharmaceutical combination or method as defined under 5.11a to 5.13a above the activity of a TSC-compound of the present invention or a second drug substance may be enhanced compared with single treatment, e.g. combined treatment may result in synergistic effects or may overcome resistance against a TSC-compound of the present invention or a chemotherapeutic agent, e.g. when used in any method or use as defined under 1.1 , 1.8, 1.2a to 1.7a, or 2.1 to 2.4 above.
• a pharmaceutical combination or method as defined under 5.11b to 5.13b above the activity of a NF1 -compound of the present invention or a second drug substance may be enhanced compared with single treatment, e.g.
• NF1 -compound of the present invention may result in synergistic effects or may overcome resistance against a NF1 -compound of the present invention or a chemotherapeutic agent, e.g. when used in any method or use as defined under 1.1, 1.8 or 1.2b to 1.6b above.
• a (pharmaceutical) combination e.g. composition as indicated under 5.1b to 5.13b comprises a) a first agent which is a NF1 -compound of the present invention and b) a second drug substance as a co-agent which is a chemotherapeutic agent, e. g. as defined hereinafter or hereinbefore.
• Treatment as provided by the present invention includes prophylaxis (prevention).
• Disorders as used herein include diseases.
• an indicated daily dosage includes a range
• a compound of the present invention may be administered as appropriate, e.g. in dosages which are known for compounds of the present invention, by any administration route, e.g. enterally, e.g. orally, or parenterally.
• E.g. everolimus may be administered, e.g. orally, in dosages from 0.1 mg up to 15 mg, such as 0.1 mg to 10 mg. e.g. 0.1 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 2.5 mg, 5 mg, or 10 mg, more preferably from 0.5 mg to 10 mg, e.g.
• rapamycin derivatives either TSC-compound or NF1 compounds, of the present invention may be administered analogously, e.g. in similar dosage ranges.
• a second drug substance may be administered in combination therapy as appropriate, e.g. according to a method as conventional, e.g. analogously to administration indications given for a specified drug for single treatment.
• a second drug substance as used herein may be administered by any conventional route, for example enterally, e.g. including nasal, buccal, rectal, oral, administration; parenterally, e.g. including intravenous, intraarterial, intramuscular, intracardiac, subcutanous, intraosseous infusion, transdermal (diffusion through the intact skin), transmucosal (diffusion through a mucous membrane), inhalational administration; topically; e.g.
• stents e.g. in form of coated or uncoated tablets, capsules, (injectable) solutions, infusion solutions, solid solutions, suspensions, dispersions, solid dispersions; e.g.
• a second drug substance as used herein may be administered in the form of a pharmaceutically acceptable salt, or in free form; optionally in the form of a solvate.
• Pharmaceutical compositions according to the present invention may be manufactured according, e.g. analogously, to a method as conventional, e.g. by mixing, granulating, coating, dissolving or lyophilizing processes. Unit dosage forms may contain, for example, from about 0.1 mg to about 1500 mg, such as 1 mg to about 1000 mg.
• compositions comprising a combination of the present invention and pharmaceutical compositions comprising a second drug substance as described herein, may be provided as appropriate, e.g. according, e.g. analogously, to a method as conventional, or as described herein for a pharmaceutical composition of the present invention.
• a method for treating diseases mediated via the Tuberous Sclerosis Complex includes diseases which are the result of a defective Tsc pathway in a subject.
• a "defective Tsc pathway” includes regulation of the Tsc pathway that results in a biological effect that causes adverse effects on a cell or tissue within the Tsc pathway, e.g., phenotypically, genetically, biochemically, and moleculariy, manifesting in tuberous sclerosis disease.
• a defective TSC pathway may be identified as appropriate, e.g. according to a method as conventional.
• Tuberous sclerosis include dysfunctions which are neurological in nature and renal dysfunction. Symptoms and diseases associated with tuberous sclerosis disease e.g. include seizures, mental retardation, autism, kidney failure, facial angiofibromas and cardial
• Rhabdomyomas cyst-like areas within certain skeletal regions, particularly bones of the fingers and toes (phalanges); characteristic skin lesions including sharply defined areas of decreased skin coloration (hypopigmentation), relatively small reddish nodules that may appear on the cheeks and nose which reddish lesions eventually enlarge, blend together (coalesce), and develop a wart-like appearance (sebaceous adenomas), flat,”coffee- colored”areas of increased skin pigmentation (cafe-au-lait spots); benigns, fibrous nodules (fibromas), e.g.
• hypertrophy referring to the enlargement or overgrowth of an organ or body part due to an increase in size of its constituent cells, e.g. including right ventricular hypertrophy, hypertrophic cardiomyopathy, benign prostatic hypertrophy; renal angiomyolipomas (AMLs). e.g. manifesting in heterogeneous, benign tumors, e.g.
• lung disease such as lymphangioleiomyomatosis (LAM), blocked flow of air, blood, and lymph to and from the lungs, kidney tumors associated with LAM, dysapnea, chronic cough, wheezing, pneumothorax, and chest pain, cystic parenchymal destruction, progressive respiratory failure.
• LAM lymphangioleiomyomatosis
• second drug substance is meant either any chemotherapeutic agent other than a compound of the present invention, either a TSC-compound or a NF1- compound.
• a second drug substance as used herein includes e.g. anticancer drugs, anti- inflammatory and/or immunomodulatory and/or antiallergic drugs, antipruritics, astringent agents, local anesthetics.
• a second drug substance as used herein includes e.g. drugs which are useful in the treatment of symptoms associated with disorders mediated via the Tuberous Sclerosis Complex, such as drugs, useful for the treatment of tuberous sclerosis, renal angiomyolipomas (ALM), lymphangioleiomyomatosis
• drugs which are useful in the treatment of tuberous sclerosis, renal angiomyolipomas (ALM), lymphangioleiomyomatosis
• LAM subependymal
• SEGAs giant cell astrocytomas
• a second drug substance as used herein includes e.g. drugs which are useful in the treatment of NF1 and/or disorders and/or symptoms associated therewith in case of a NF1 -compound of the present invention.
• Anticancer drugs which are prone to be useful as a combination partner with any compound of the present invention, either a TSC-compound or a NF1 -compound, e.g. prone to be useful according to the present invention, e.g. include i. a steroid; e.g. prednisone. ii.
• an adenosine-kinase-inhibitor which targets, decreases or inhibits nucleobase, nucleoside, nucleotide and nucleic acid metabolisms, such as 5-lodotubercidin, which is also known as 7H-pyrrolo[2,3-d]pyrimidin-4-amine, 5-iodo-7-/?-D-ribofuranosyl-(9CI).
• 5-lodotubercidin which is also known as 7H-pyrrolo[2,3-d]pyrimidin-4-amine, 5-iodo-7-/?-D-ribofuranosyl-(9CI).
• an adjuvant which enhances the 5-FU-TS bond as well as a compound which targets, decreases or inhibits, alkaline phosphatase, such as leucovorin, levamisole.
• an adrenal cortex antagonist which targets, decreases or inhibits the activity of the adrenal cortex and changes the peripheral metabolism of corticosteroids, resulting in a decrease in 17-hydroxycorticosteroids, such as mitotane.
• an AKT pathway inhibitor such as a compound which targets, decreases or inhibits Akt, also known as protein kinase B (PKB), such as deguelin, which is also known as 3H-bis[1]benzopyrano[3,4-b:6',5'-e]pyran-7(7aH)-one, 13,13a-dihydro-9,10-dimethoxy- 3,3-dimethyl-, (7aS, 13aS)-(9CI); and triciribine, which is also known as 1,4,5,6,8- pentaazaacenaphthylen-3-amine, 1,5-dihydro-5-methyl-1- / ff-D-ribofuranosyl-(9CI).
• an alkylating agent which causes alkylation of DNA and results in breaks in the DNA molecules as well as cross-linking of the twin strands, thus interfering with DNA replication and transcription of RNA, such as chlorambucil, chlormethine, cyclophosphamide, ifosfamide, melphalan, estramustine; nitrosueras, such as carmustine, fotemustine, lomustine, streptozocin (streptozotocin, STZ), BCNU; Gliadel; dacarbazine, mechlorethamine, e.g. in the form of a hydrochloride, procarbazine, e.g.
• Cyclophosphamide can be administered, e.g., in the form as it is marketed, e.g., under the trademark CYCLOSTIN®; ifosfamide as HOLOXAN®, temozolomide as TEMODAR®, nitrogen mustard as MUSTARGEN®, estramustine as EMYCT®, streptozocin as ZANOSAR®.
• an angiogenesis inhibitor which targets, decreases or inhibits the production of new blood vessels, e.g.
• Methionine aminopeptidase-2 (MetAP-2), macrophage inflammatory protein-1 (MIP-1alpha), CCL5, TGF-beta, lipoxygenase, cyclooxygenase, and topoisomerase, or which indirectly targets p21, p53, CDK2 and collagen synthesis, e.g.
• fumagillin which is known as 2,4,6,8- decatetraenedioic acid, mono[(3R,4S,5S,6R)-5-methoxy-4-[(2R,3R)-2-methyl-3-(3- methyl-2-butenyl)oxiranyl]-1-oxaspiro[2.5]oct-6-yl] ester, (2E,4E,6E,8E)- (9Cl); shikonin, which is also known as 1 ,4-naphthalenedione, 5,8-dihydroxy-2-[(1R)-1- hydroxy-4-methyl-3-pentenyl]- (9Cl); tranilast, which is also known as benzoic acid, 2-
• US4636505 ix. an anti-estrogen; which antagonizes the effect of estrogens at the estrogen receptor level, e.g. including an aromatase inhibitor, which inhibits the estrogen production, i. e. the conversion of the substrates androstenedione and testosterone to estrone and estradiol, respectively, e.g.
• Tamoxifen may be e.g. administered in the form as it is marketed, e.g., NOLVADEX®; and raloxifene hydrochloride is marketed as EVIST A®. Fulvestrant may be formulated as disclosed in
• an antimetabolite which inhibits or disrupts the synthesis of DNA resulting in cell death, such as 6-mercaptopurine; cytarabine; fludarabine; flexuridine; fluorouracil; 5- fluorouracil(5-FU), floxuridine (5-FUdR), capecitabine; raltitrexed; methotrexate; cladribine; gemcitabine; gemcitabine hydrochloride; thioguanine; 6-thioguanine, hydroxyurea; DNA de-methylating agents, such as 5-azacytidine and decitabine; edatrexate; folic acid antagonists such as pemetrexed. Capecitabine and gemcitabine can be administered e.g.
• XELODA® and GEMZAR® in the marketed form, such as XELODA® and GEMZAR®.
• xii an apoptosis inducer; which induces the normal series of events in a cell that leads to its death, e.g. selectively inducing the X-linked mammalian inhibitor of apoptosis protein XIAP 1 or e.g. downregulating BCL-xL; such as ethanol, 2-[[3-(2,3- dichlorophenoxy)propyl]amino]-(9CI); gambogic acid; embelin, which is also known as
• xiii an aurora kinase inhibitor; which targets, decreases or inhibits later stages of the cell cycle from the G2/M check point all the way through to the mitotic checkpoint and late mitosis; such as binucleine 2, which is also known as methanimidamide, N'-[1-(3- chloro- ⁇ fluorophenyO ⁇ -cyano-IH-pyrazol- ⁇ -yll-N.N-dimethyl- (9Cl).
• xiv. a Bruton's Tyrosine Kinase (BTK) inhibitor which targets, decreases or inhibits human and murine B cell development; such as terreic acid.
• a calcineurin inhibitor which targets, decreases or inhibits the T cell activation pathway, such as cypermethrin, which is also known as cyclopropanecarboxylic acid,
• a CaM kinase Il inhibitor which targets, decreases or inhibits CaM kinases; constituting a family of structurally related enzymes that include phosphorylase kinase, myosin light chain kinase, and CaM kinases I-IV; such as 5-isoquinolinesulfonic acid, 4-[(2S)-2-[(5-isoquinolinylsulfonyl)methylamino]-3-oxo-3-(4-phenyl-1- piperazinyl)propyl]phenyl ester (9Cl); benzenesulfonamide, N-[2-[[[[3-(4-chlorophenyl)- 2-propenyl]methyl]amino]methyl]phenyl]-N-(2-hydroxyethyl)-4-
• xvii. a CD45 tyrosine phosphatase inhibitor; which targets, decreases or inhibits dephosphorylating regulatory pTyr residues on Src-family protein-tyrosine kinases, which aids in the treatment of a variety of inflammatory and immune disorders; such as phosphonic acid, [[2-(4-bromophenoxy)-5-nitrophenyl]hydroxymethyl]-(9CI).
• xviii a CDC25 phosphatase inhibitor; which targets, decreases or inhibits overexpressed dephosphorylate cyclin-dependent kinases in tumors; such as 1 ,4-naphthalenedione,
• a CHK kinase inhibitor which targets, decreases or inhibits overexpression of the antiapoptotic protein Bcl-2; such as debromohymenialdisine.
• Targets of a CHK kinase inhibitor are CHK1 and/or CHK2.
• a controlling agent for regulating genistein, olomucine and/or tyrphostins such as daidzein, which is also known as 4H-1-benzopyran-4-one, 7-hydroxy-3-(4- hydroxyphenyl)-(9CI); Iso-Olomoucine, and Tyrphostin 1.
• daidzein which is also known as 4H-1-benzopyran-4-one, 7-hydroxy-3-(4- hydroxyphenyl)-(9CI); Iso-Olomoucine, and Tyrphostin 1.
• daidzein which is also known as 4H-1-benzopyran-4-one, 7-hydroxy-3-(4- hydroxyphenyl)-(9CI); Iso-Olomoucine, and Tyrphostin 1.
• a cyclooxygenase inhibitor e.g.
• Cox-2 inhibitors which targets, decreases or inhibits the enzyme cox-2 (cyclooxygenase-2); such as 1 H-indole-3-acetamide, 1-(4- chlorobenzoyl)-5-methoxy-2-methyl-N-(2-phenylethyl)-(9CI); 5-alkyl substituted 2- arylaminophenylacetic acid and derivatives, e.g.
• celecoxib CELEBREX®
• rofecoxib VIOXX®
• etoricoxib valdecoxib
• valdecoxib or a 5-alkyl-2-arylaminophenylacetic acid, e.g., 5- methyl-2-(2'-chloro-6'-fluoroanilino)phenyl acetic acid, lumiracoxib; and celecoxib.
• a cRAF kinase inhibitor which targets, decreases or inhibits the up-regulation of E- selectin and vascular adhesion molecule-1 induced by TNF; such as 3-(3,5-dibromo-4- hydroxybenzylidene)-5-iodo-1 ,3-dihydroindol-2-one; and benzamide, 3- (dimethylamino)-N-[3-[(4-hydroxybenzoyl)amino]-4-methylphenyl]-(9CI).
• Raf kinases play an important role as extracellular signal-regulating kinases in cell differentiation, proliferation, and apoptosis.
• a target of a cRAF kinase inhibitor includes, but is not limited, to RAF1.
• a cyclin dependent kinase inhibitor which targets, decreases or inhibits cyclin dependent kinase playing a role in the regulation of the mammalian cell cycle; such as N9-isopropyl-olomoucine; olomoucine; purvalanol B, which is also known as Benzoic acid, 2-chloro-4-[[2-[[[(1R)-1-(hydroxymethyl)-2-methylpropyl]amino]-9-(1-methylethyl)- 9H-purin-6-yl]amino]- (9Cl); roascovitine; indirubin, which is also known as 2H-indol-2- one, 3-(1,3-dihydro-3-oxo-2H-indol-2-ylidene)-1,3-dihydro- (9Cl);
• Cdks cyclin dependent kinases
• cyclins are a group of serine/threonine kinases that form active heterodimeric complexes by binding to their regulatory subunits, cyclins.
• targets of a cyclin dependent kinase inhibitor include, but are not limited to, CDK, AHR, CDK1 , CDK2,
• a cysteine protease inhibitor which targets, decreases or inhibits cystein protease which plays a vital role in mammalian cellular turnover and apotosis; such as 4- morpholinecarboxamide,N-[(1S)-3-fluoro-2-oxo-1-(2-phenylethyl)propyl]amino]-2-oxo- 1 -(phenylmethyl)ethyl]-(9CI).
• a DNA intercalator which binds to DNA and inhibits DNA, RNA, and protein synthesis; such as plicamycin, dactinomycin.
• a DNA strand breaker which causes DNA strand scission and results in inhibition of
• RNA synthesis DNA synthesis, ininhibition of RNA and protein synthesis; such as bleomycin.
• an E3 Ligase inhibitor which targets, decreases or inhibits the E3 ligase which inhibits the transfer of ubiquitin chains to proteins, marking them for degradation in the proteasome; such as N-((3,3,3-trifluoro-2-trifluoromethyl)propionyl)sulfanilamide.
• an endocrine hormone which by acting mainly on the pituitary gland causes the suppression of hormones in males, the net effect being a reduction of testosterone to castration levels; in females, both ovarian estrogen and androgen synthesis being inhibited; such as leuprolide; megestrol, megestrol acetate.
• compounds targeting, decreasing or inhibiting the activity of the epidermal growth factor family of receptor tyrosine kinases EGFR, ErbB2, ErbB3, ErbB4 as homo- or heterodimers
• compounds targeting, decreasing or inhibiting the activity of the epidermal growth factor family of receptor tyrosine kinases (EGFR, ErbB2, ErbB3, ErbB4 as homo- or heterodimers), such as compounds, proteins or antibodies which inhibit members of the EGF receptor tyrosine kinase family, e.g.
• EGF receptor, ErbB2, ErbB3 and ErbB4 or bind to EGF or EGF-related ligands, and are in particular those compounds, proteins or monoclonal antibodies generically and specifically disclosed in WO 9702266, e.g. the compound of ex. 39, EP0564409, WO9903854, EP0520722, EP0566226, EP0787722, EP0837063, US5747498, WO9810767, WO9730034, WO9749688, WO9738983 and, especially, WO9630347, e.g. a compound known as CP 358774, WO9633980, e.g. a compound known as ZD 1839; and WO 9503283, e.g.
• WO 9702266 e.g. the compound of ex. 39, EP0564409, WO9903854, EP0520722, EP0566226, EP0787722, EP0837063, US5747498, WO9810767
• ZM105180 a compound known as ZM105180, e.g including trastuzumab (HERCEPTIN ® ), cetuximab, iressa, OSI-774, CI-1033, EKB-569, GW-2016, E1.1 , E2.4, E2.5, E6.2, E6.4, E2.11 , E6.3 or E7.6.3, 7H-pyrrolo-[2,3-d]pyrimidine derivatives which are e.g. disclosed in WO03013541 , erlotinib, gefitinib. Erlotinib can be administered in the form as it is marketed, e.g.
• TARCEVA® and gefitinib as IRESSA®, human monoclonal antibodies against the epidermal growth factor receptor including ABX-EGFR.
• an EGFR, PDGFR tyrosine kinase inhibitor such as EGFR kinase inhibitors including tyrphostin 23, tyrphostin 25, tyrphostin 47, tyrphostin 51 and tyrphostin AG 825; 2- propenamide, 2-cyano-3-(3,4-dihydroxyphenyl)-N-phenyl-(2E)-(9CI); tyrphostin Ag 1478; lavendustin A; 3-pyridineacetonitrile, ⁇ -[(3,5-dichlorophenyl)methylene]-, ( ⁇ Z)- (9Cl); an example of an EGFR, PDGFR tyrosine kinase inhibitor e.g.
• tyrphostin 46 includes tyrphostin 46.
• PDGFR tyrosine kinase inhibitor including tyrphostin 46.
• Targets of an EGFR kinase inhibitor include guanylyl cyclase (GC-C) HER2, EGFR, PTK and tubulin, xxxi.
• GC-C guanylyl cyclase
• a farnesyltransferase inhibitor which targets, decreases or inhibits the Ras protein; such as a-hydroxyfarnesylphosphonic acid; butanoic acid, 2-[[(2S)-2-[[(2S,3S)- 2-[[(2R)-2-amino-3-mercaptopropyl]amino]-3-methylpentyl]oxy]-1-oxo-3- phenylpropyl]amino]-4-(methylsulfonyl)-,1-methylethyl ester, (2S)-(9cl); manumycin A; L-744,832 or DK8G557, tipifamib (R115777), SCH66336 (lonafarnib), BMS-214662, xxxii.
• a Flk-1 kinase inhibitor which targets, decreases or inhibits Flk-1 tyrosine kinase activity; such as 2-propenamide, 2-cyano-3-[4-hydroxy-3,5-bis(1-methylethyl)phenyl]- N-(3-phenylpropyl)-(2E)-(9CI).
• a target of a Flk-1 kinase inhibitor includes, but is not limited to, KDR. xxxiii. a Glycogen synthase kinase-3 (GSK3) inhibitor; which targets, decreases or inhibits glycogen synthase kinase-3 (GSK3); such as indirubin-3'-monooxime.
• Glycogen Synthase Kinase-3 (GSK-3; tau protein kinase I), a highly conserved, ubiquitously expressed serine/threonine protein kinase, is involved in the signal transduction cascades of multiple cellular processes, which is a protein kinase that has been shown to be involved in the regulation of a diverse array of cellular functions, including protein synthesis, cell proliferation, cell differentiation, microtubule assembly/disassembly, and apoptosis.
• HDAC histone deacetylase
• SAHA suberoylanilide hydroxamic acid
• HSP90 inhibitor which targets, decreases or inhibits the intrinsic ATPase activity of HSP90; degrades, targets, decreases or inhibits the HSP90 client proteins via the ubiquitin proteosome pathway.
• Compounds targeting, decreasing or inhibiting the intrinsic ATPase activity of HSP90 are especially compounds, proteins or antibodies which inhibit the ATPase activity of HSP90, e.g., 17-allylamino,17- demethoxygeldanamycin (17AAG), a geldanamycin derivative; other geldanamycin- related compounds; radicicol and HDAC inhibitors.
• HSP90 inhibitor examples include geldanamycin,17-demethoxy-17-(2-propenylamino)-(9CI).
• Potential indirect targets of an HSP90 inhibitor include FLT3, BCR-ABL, CHK1 , CYP3A5 * 3 and/or NQ01 * 2.
• a l-kappa B-alpha kinase inhibitor (IKK) which targets, decreases or inhibits NF- kappaB, such as 2-propenenitrile, 3-[(4-methylphenyl)sulfonyl]-(2E)-(9CI).
• IKK l-kappa B-alpha kinase inhibitor
• an insulin receptor tyrosine kinase inhibitor which modulates the activities of phosphatidylinositol 3-kinase, microtubule-associated protein, and S6 kinases; such as hydroxyl-2-naphthalenylmethylphosphonic acid, LY294002.
• a c-Jun N-terminal kinase (JNK) kinase inhibitor which targets, decreases or inhibits Jun N-terminal kinase; such as pyrazoleanthrone and/or epigallocatechin gallate.
• JNK Jun N-terminal kinase
• a target for a JNK kinase inhibitor includes, but is not limited to, DNMT.
• xxxix a microtubule binding agent; which acts by disrupting the microtubular network that is essential for mitotic and interphase cellular function; such as vinblastine, vinblastine sulfate; vinca alkaloids, such as vincristine, vincristine sulfate; vindesine; vinorelbine; taxanes, such as docetaxel; paclitaxel; discodermolides; colchicine, epothilones and derivatives thereof, e.g. epothilone B or a derivative thereof.
• Paclitaxel is marketed as TAXOL®; docetaxel as TAXOTERE®; vinblastine sulfate as VINBLASTIN R.P®; and vincristine sulfate as FARMISTIN®. Also included are the generic forms of paclitaxel as well as various dosage forms of paclitaxel. Generic forms of paclitaxel include, but are not limited to, betaxolol hydrochloride. Various dosage forms of paclitaxel include, but are not limited to albumin nanoparticle paclitaxel marketed as ABRAXANE®; ONXOL®, CYTOTAX®. Discodermolide can be obtained, e.g., as disclosed in US5010099.
• Epotholine derivatives which are disclosed in US6194181, WO98/0121 , WO9825929, WO9808849, WO9943653, WO9822461 and WO0031247.
• MAP mitogen-activated protein
• the mitogen-activated protein (MAP) kinases are a group of protein serine/threonine kinases that are activated in response to a variety of extracellular stimuli and mediate signal transduction from the cell surface to the nucleus. They regulate several physiological and pathological cellular phenomena, including inflammation, apoptotic cell death, oncogenic transformation, tumor cell invasion, and metastasis, xli. a MDM2 inhibitor; which targets, decreases or inhibits the interaction of MDM2 and the p53 tumor suppressor; such as trans-4-iodo, 4'-boranyl-chalcone. xlii.
• a MEK inhibitor which targets, decreases or inhibits the kinase activity of MAP kinase MEK; such as Nexavar® (sorafenib tosylate), butanedinitrile, bis[amino[2- aminophenyl)thio]methylene]-(9CI).
• a target of a MEK inhibitor includes, but is not limited to ERK.
• An indirect target of a MEK inhibitor includes, but is not limited to, cyclin D1.
• xliii a matrix metalloproteinase inhibitor (MMP) inhibitor; which targets, decreases or inhibits a class of protease enzyme that selectively catalyze the hydrolysis of polypeptide bonds including the enzymes MMP-2 and MMP-9 that are involved in promoting the loss of tissue structure around tumors and facilitating tumor growth, angiogenesis, and metastasissuch as actinonin, which is also known as butanediamide, N-4-hydroxy-N 1 -[(1 S)-1 -[[(2S)-2-(hydroxymethyl)-1 - pyrrolidinyl]carbonyl]-2-methylpropyl]-2-pentyl-, (2R)-(9CI); epigallocatechin gallate; collagen peptidomimetic and non-peptidomimetic inhibitors; tetracycline derivatives, e.g., hydroxamate peptidomimetic inhibitor batimastat; and its orally-bioavailable analogue marimastat, prino
• a target of a MMP inhibitor includes, but is not limited to, polypeptide deformylase. xliv. a NGFR tyrosine-kinase-inhibitor; which targets, decreases or inhibits nerve growth factor dependent p140 c Wt tyrosine phosphorylation; such as tyrphostin AG 879.
• Targets of a NGFR tyrosine-kinase-inhibitor include, but are not limited to, HER2, FLK1 , FAK, TrkA, and/or TrkC.
• An indirect target inhibits expression of RAF1.
• a p38 MAP kinase inhibitor including a SAPK2/p38 kinase inhibitor; which targets, decreases or inhibits p38-MAPK, which is a MAPK family member, such as phenol, 4-[4-(4-fluorophenyl)-5-(4-pyridinyl)-1 H-imidazol-2-yl]-(9CI).
• SAPK2/p38 kinase inhibitor includes, but is not limited to, benzamide, 3- (dimethylamino)-N-[3-[(4-hydroxybenzoyl)amino]-4-methylphenyl]-(9CI).
• a MAPK family member is a serine/threonine kinase activated by phosphorylation of tyrosine and threonine residues. This kinase is phosphorylated and activated by many cellular stresses and inflammatory stimuli, thought to be involved in the regulation of important cellular responses such as apoptosis and inflammatory reactions, xlvi.
• a p56 tyrosine kinase inhibitor which targets, decreases or inhibits p56 tyrosine kinase, which is an enzyme that is a lymphoid-specific src family tyrosine kinase critical for T-cell development and activation; such as damnacanthal, which is also known as 2-anthracenecarboxaldehyde,9, 10-dihydro-3-hydroxy-1 methoxy-9, 10-dioxo-(9CI),
• a target of a p56 tyrosine kinase inhibitor includes, but is not limited to, Lck.
• Lck is associated with the cytoplasmic domains of CD4, CD8 and the beta-chain of the IL-2 receptor, and is thought to be involved in the earliest steps of TCR- mediated T-cell activation.
• xlvii. a PDGFR tyrosine kinase inhibitor; targeting, decreasing or inhibiting the activity of the C-kit receptor tyrosine kinases (part of the PDGFR family), such as targeting, decreasing or inhibiting the activity of the c-Kit receptor tyrosine kinase family, especially inhibiting the c-Kit receptor.
• targets of a PDGFR tyrosine kinase inhibitor includes, but are not limited to PDGFR, FLT3 and/or c-KIT; such as tyrphostin AG 1296; tyrphostin 9; 1 ,3-butadiene-1 ,1 ,3-tricarbonitrile,2-amino-4-(1 H- indol-5-yl)-(9CI); N-phenyl-2-pyrimidine-amine derivative, e. g. imatinib, IRESSA®.
• PDGF plays a central role in regulating cell proliferation, chemotaxis, and survival in normal cells as well as in various disease states such as cancer, atherosclerosis, and fibrotic disease.
• the PDGF family is composed of dimeric isoforms (PDGF-AA, PDGF- BB, PDGF-AB, PDGF-CC, and PDGF-DD), which exert their cellular effects by differentially binding to two receptor tyrosine kinases.
• PDGFR-* and PDGFR- ⁇ have molecular masses of -170 and 180 kDa, respectively. xlviii.
• a phosphatidylinositol 3-kinase inhibitor which targets, decreases or inhibits Pl 3- kinase; such as wortmannin, which is also known as 3H-Furo[4,3,2-de]indeno[4,5-h]-2- benzopyran-3,6,9-trione, 11 -(acetyloxy)-i ,6b,7,8,9a, 10,11 ,11 b-octahydro-1 - (methoxymethyl)-9a,11b-dimethyl-, (1S,6bR,9aS,11R,11bR)- (9Cl); 8-phenyl-2- (morpholin-4-yl)-chromen-4-one; quercetin, quercetin dihydrate.
• wortmannin which is also known as 3H-Furo[4,3,2-de]indeno[4,5-h]-2- benzopyran-3,6,9-trione, 11 -(acetyloxy)-i ,
• Pl 3-kinase activity has been shown to increase in response to a number of hormonal and growth factor stimuli, including insulin, platelet-derived growth factor, insulin-like growth factor, epidermal growth factor, colony-stimulating factor, and hepatocyte growth factor, and has been implicated in processes related to cellular growth and transformation.
• hormonal and growth factor stimuli including insulin, platelet-derived growth factor, insulin-like growth factor, epidermal growth factor, colony-stimulating factor, and hepatocyte growth factor.
• An example of a target of a phosphatidylinositol 3-kinase inhibitor includes, but is not limited to, Pi3K. xlix.
• a phosphatase inhibitor which targets, decreases or inhibits phosphatase; such as cantharidic add; cantharidin; and L-leucinamide, N-[4-(2- carboxyethenyl)benzoyl]glycyl-L- ⁇ -glutamyl-(E)-(9CI).
• Phosphatases remove the phosphoryl group and restore the protein to its original dephosphorylated state. Hence, the phosphorylation- dephosphorylation cycle can be regarded as a molecular "on-off switch.
• platinum agent which contains platinum and inhibit DNA synthesis by forming interstrand and intrastrand cross-linking of DNA molecules; such as carboplatin; cisplatin; oxaliplatin; cisplatinum; satraplatin and platinum agents such as ZD0473.
• Carboplatin can be administered, e.g., in the form as it is marketed, e.g. CARBOPLAT®; and oxaliplatin as ELOXATIN®.
• a protein phosphatase inhibitor including a PP1 and PP2 inhibitor and a tyrosine phosphatase inhibitor; which targets, decreases or inhibits protein phosphatase.
• a PP1 and PP2A inhibitor include cantharidic acid and/or cantharidin.
• a tyrosine phosphatase inhibitor include, but are not limited to, L-P- bromotetramisole oxalate; 2(5H)-furanone,4-hydroxy-5-(hydroxymethyl)-3-(1- oxohexadecyl)-, (5R)-(9CI); and benzylphosphonic acid.
• a PP1 or PP2 inhibitor relates to a compound which targets, decreases or inhibits Ser/Thr protein phosphatases.
• Type I phosphatases which include PP1, can be inhibited by two heat-stable proteins known as lnhibitor-1 (I- 1 ) and lnhibitor-2 (I-2). They preferentially dephosphorylate a subunit of phosphorylase kinase.
• Type Il phosphatases are subdivided into spontaneously active (PP2A), CA 2+ - dependent (PP2B), and Mg 2+ -dependent (PP2C) classes of phosphatases.
• tyrosine phosphatase inhibitor as used here, relates to a compounds which targets, decreases or inhibits tyrosine phosphatase. Protein tyrosine phosphatases
• PTPs are relatively recent additions to the phosphatase family. They remove phosphate groups from phosphorylated tyrosine residues of proteins. PTPs display diverse structural features and play important roles in the regulation of cell proliferation, differentiation, cell adhesion and motility, and cytoskeletal function. Examples of targets of a tyrosine phosphatase inhibitor include, but are not limited to, alkaline phosphatase (ALP), heparanase, PTPase, and/or prostatic acid phosphatase.
• ALP alkaline phosphatase
• heparanase heparanase
• PTPase and/or prostatic acid phosphatase.
• a PKC inhibitor relates to a compound which targets, decreases or inhibits protein kinase C as well as its isozymes.
• PKC Protein kinase C
• Examples of a target of a PKC inhibitor include, but are not limited to, MAPK and/or NF-kappaB.
• PKC inhibitor examples include, but are not limited to, 1-H-pyrrolo-2,5-dione,3-[1-[3-(dimethylamino)propyl]-1H-indol-3-yl]-4- (1 H-indol-3-yl)-(9CI); bisindolylmaleimide IX; sphingosine, which is known as 4- octadecene-1 ,3-diol, 2-amino-, (2S,3R,4E)- (9Cl); staurosporine, which is known as
• a PKC delta kinase inhibitor relates to a compound which targets, decreases or inhibits the delta isozymes of PKC.
• the delta isozyme is a conventional PKC isozymes and is Ca 2+ -dependent.
• An example of a PKC delta kinase inhibitor includes, but is not limited to, Rottlerin, which is also known as 2-Propen-1-one, 1-[6-[(3-acetyl-2,4,6-trihydroxy-5-methylphenyl)methyl]-5,7- dihydroxy-2,2-dimethyl-2H-1 -benzopyran-8-yl]-3-phenyl-, (2E)- (9Cl). liii.
• a polyamine synthesis inhibitor which targets, decreases or inhibits polyamines spermidine; such as DMFO, which is also known as (-)-2-difluoromethylornithin; N1 , N12-diethylspermine 4HCI.
• DMFO polyamines spermidine and spermine are of vital importance for cell proliferation, although their precise mechanism of action is unclear. Tumor cells have an altered polyamine homeostasis reflected by increased activity of biosynthetic enzymes and elevated polyamine pools.
• Hv a proteosome inhibitor; which targets, decreases or inhibits proteasome, such as aclacinomycin A; gliotoxin; PS-341 ; MLN 341 ; bortezomib; velcade.
• targets of a proteosome inhibitor include, but are not limited to, O(2)(-)-generating NADPH oxidase, NF-kappaB, and/or farnesyltransferase, geranyltransferase I.
• a PTP1B inhibitor which targets, decreases or inhibits PTP1B, a protein tyrosine kinase inhibitor; such as L-leucinamide, N-[4-(2-carboxyethenyl)benzoyl]glycyl-L- ⁇ - glutamyl-,(E)-(9CI).
• IvL a protein tyrosine kinase inhibitor including a SRC family tyrosine kinase inhibitor; a Syk tyrosine kinase inhibitor; and a JAK-2 and/or JAK-3 tyrosine kinase inhibitor;
• a protein tyrosine kinase inhibitor relates to a compound which which targets, decreases or inhibits protein tyrosine kinases.
• Protein tyrosine kinases (PTKs) play a key role in the regulation of cell proliferation, differentiation, metabolism, migration, and survival. They are classified as receptor PTKs and non- receptor PTKs.
• Receptor PTKs contain a single polypeptide chain with a transmembrane segment. The extracellular end of this segment contains a high affinity ligand-binding domain, while the cytoplasmic end comprises the catalytic core and the regulatory sequences.
• targets of a tyrosine kinase inhibitor include, but are not limited to, ERK1, ERK2, Bruton's tyrosine kinase (Btk), JAK2, ERK !4, PDGFR, and/or FLT3.
• targets of indirect targets include, but are not limited to, TNFalpha,
• tyrosine kinase inhibitor examples include, but are not limited to, tyrphostin AG 126; tyrphostin Ag 1288; tyrphostin Ag 1295; geldanamycin; and genistein.
• Non-receptor tyrosine kinases include members of the Src, Tec, JAK, Fes, AbI, FAK, Csk, and Syk families. They are located in the cytoplasm as well as in the nucleus.
• a SRC family tyrosine kinase inhibitor relates to a compound which which targets, decreases or inhibits SRC.
• SRC family tyrosine kinase inhibitor examples include, but are not limited to, PP1 , which is also known as 1H-pyrazolo[3,4-d]pyrimidin-4-amine, 1-(1,1-dimethylethyl)-3-(1-naphthalenyl)- (9CI); and PP2, which is also known as 1 H-Pyrazolo[3,4-d]pyrimidin-4-amine, 3-(4- chlorophenyl)-1-(1 ,1-dimethylethyl)- (9Cl).
• a Syk tyrosine kinase inhibitor as used herein, relates to a compound which targets, decreases or inhibits Syk.
• targets for a Syk tyrosine kinase inhibitor include, but are not limited to, Syk, STAT3, and/or STAT5.
• An example of a Syk tyrosine kinase inhibitor includes, but is not limited to, piceatannol, which is also known as 1 ,2-benzenediol, 4-[(1 E)-2-(3,5-dihydroxyphenyl)ethenyl]- (9Cl).
• the term "a Janus (JAK-2 and/or JAK-3) tyrosine kinase inhibitor” relates to a compound which targets, decreases or inhibits janus tyrosine kinase.
• Janus tyrosine kinase inhibitor are shown anti-leukemic agents with anti-thrombotic, anti-allergic and immunosuppressive properties.
• Targets of a JAK-2 and/or JAK-3 tyrosine kinase inhibitor include, but are not limited to, JAK2, JAK3, STAT3.
• An indirect target of an JAK-2 and/or JAK-3 tyrosine kinase inhibitor includes, but is not limited to CDK2.
• Examples of a JAK-2 and/or JAK-3 tyrosine kinase inhibitor include, but are not limited to, Tyrphostin AG 490; and 2-naphthyl vinyl ketone.
• Compounds which target, decrease or inhibit the activity of c-Abl family members and their gene fusion products include PD180970 ; AG957; or NSC 680410.
• a retinoid which target, decrease or inhibit retinoid dependent receptors; such as isotretinoin, tretinoin.
• RNA polymerase Il elongation inhibitor which targets, decreases or inhibits insulin- stimulated nuclear and cytosolic p70S6 kinase in CHO cells; targets, decreases or inhibits RNA polymerase Il transcription, which may be dependent on casein kinase II; and targets, decreases or inhibits germinal vesicle breakdown in bovine oocytes; such as 5,6-dichloro-1 -beta-D-ribofuranosylbenzimidazole.
• a serine/threonine kinase inhibitor which inhibits serine/threonine kinases; such as 2- aminopurine, also known as 1H-purin-2-amine(9CI).
• An example of a target of a serine/threonine kinase inhibitor includes, but is not limited to, dsRNA-dependent protein kinase (PKR).
• Examples of indirect targets of a serine/threonine kinase inhibitor include, but are not limited to, MCP-1, NF-kappaB, elF2alpha, COX2, RANTES, IL8.CYP2A5, IGF-1 , CYP2B1 , CYP2B2, CYP2H1 , ALAS-1, HIF-1 , erythropoietin, and/or CYP1A1.
• Ix. a sterol biosynthesis inhibitor which inhibits the biosynthesis of sterols such as cholesterol; such as terbinadine.
• targets for a sterol biosynthesis inhibitor include, but are not limited to, squalene epoxidase, and CYP2D6.
• topoisomerase inhibitor examples include, but are not limited to, topotecan, gimatecan, irinotecan, camptothecan and its analogues, 9- nitrocamptothecin and the macromolecular camptothecin conjugate PNU-166148 (the compound designated as A1 in WO9917804); 10-hydroxycamptothecin acetate salt; etoposide; idarubicin hydrochloride; irinotecan hydrochloride; teniposide; topotecan, topotecan hydrochloride; doxorubicin; epirubicin, epirubicin hydrochloride; mitoxantrone, mitoxantrone hydrochloride; daunorubicin, daunorubicin hydrochloride, dasatinib (BMS-354825).
• Irinotecan can be administered, e.g., in the form as it is marketed, e.g., under the trademark CAMPTOSAR®.
• Topotecan can be administered, e.g., in the form as it is marketed, e.g., under the trademark HYCAMTIN®.
• topoisomerase Il inhibitor includes, but is not limited to, the anthracyclines, such as doxorubicin, including liposomal formulation, e.g., CAELYX®, daunorubicin, including liposomal formulation, e.g., DAUNOSOME®, epirubicin, idarubicin and nemorubicin; the anthraquinones mitoxantrone and losoxantrone; and the podophillotoxines etoposide and teniposide.
• Etoposide is marketed as ETOPOPHOS®; teniposide as VM 26-BRISTOL®; doxorubicin as ADRIBLASTIN® or
• VEGFR tyrosine kinase inhibitor which targets, decreases and/or inhibits the known angiogenic growth factors and cytokines implicated in the modulation of normal and pathological angiogenesis.
• the VEGF family (VEGF-A, VEGF-B, VEGF-C, VEGF-D) and their corresponding receptor tyrosine kinases [VEGFR-1 (Flt-1 ), VEGFR-2 (Flk-1 , KDR), and VEGFR-3 (Flt-4)] play a paramount and indispensable role in regulating the multiple facets of the angiogenic and lymphangiogenic processes.
• VEGFR tyrosine kinase inhibitor includes 3-(4-dimethylaminobenzylidenyl)-2- indolinone.
• Compounds which target, decrease or inhibit the activity of VEGFR are especially compounds, proteins or antibodies which inhibit the VEGF receptor tyrosine kinase, inhibit a VEGF receptor or bind to VEGF, and are in particular those compounds, proteins or monoclonal antibodies generically and specifically disclosed in WO9835958, e. g.1- (4- chloroanilino)-4- (4-pyridylmethyl) phthalazine or a pharmaceutical acceptable salt thereof, e. g.
• antibody By antibody is meant intact monoclonal antibodies, polyclonal antibodies, multispecific antibodies formed from at least 2 intact antibodies, and antibodies fragments so long as they exhibit the desired biological activity, an example of an VEGF-R2 inhibitor e.g. includes axitinib,
• Ixiii. a gonadorelin agonist such as abarelix, goserelin, goserelin acetate
• Ixiv. a compound which induce cell differentiation processes such as retinoic acid, alpha-, gamma- or 8- tocopherol or alpha-, gamma- or 8-tocotrienol.
• Ixv a bisphosphonate, e.g. including etridonic, clodronic, tiludronic, pamidronic, alendronic, ibandronic, risedronic and zoledronic acid.
• a bisphosphonate e.g. including etridonic, clodronic, tiludronic, pamidronic, alendronic, ibandronic, risedronic and zoledronic acid.
• telomere inhibitor e. g. telomestatin
• mediators such as inhibitors of catechol-O-methyltransferase, e.g. entacapone,
• Ixx ispinesib, permetrexed (Alimta®), sunitinib (SU 11248), diethylstilbestrol (DES), BMS224818 (LEA29Y),
• Ixxi somatostatin or a somatostatin analogue such as octreotide (Sandostatin® or Sandostatin LAR®).
• Growth Hormone-Receptor Antagonists such as pegvisomant, filgrastim or pegfilgrastim, or interferon alpha.
• Anti-inflammatory and/or immunomodulatory drugs which are prone to be useful in combination with a compound of the present invention, either a TSC-compound or a NF1- compound, e.g. prone to be useful according to the present invention, e.g. include
• mediators e.g. inhibitors, of calcineurin, e.g. cyclosporin A, FK 506; - ascomycins having immuno-suppressive properties, e.g. ABT-281 , ASM981;
• mycophenolic acid or salt e.g. sodium, mycophenolate mofetil
• mediators e.g. inhibitors, of bcr-abl tyrosine kinase activity
• mediators e.g. inhibitors, of c-kit receptor tyrosine kinase activity
• - mediators e.g. inhibitors, of PDGF receptor tyrosine kinase activity, e.g. Gleevec (imatinib);
• mediators e.g. inhibitors, of p38 MAP kinase activity
• mediators e.g. inhibitors, of VEGF receptor tyrosine kinase activity
• - mediators e.g. inhibitors, of PKC activity, e.g. as disclosed in WO0238561 or WO0382859, e.g. the compound of Example 56 or 70;
• - mediators e.g. inhibitors, of JAK3 kinase activity, e.g. N-benzyl-3,4-dihydroxy-benzylidene- cyanoacetamide ⁇ -cyano-(3,4-dihydroxy)-]N-benzylcinnamamide (Tyrphostin AG 490), prodigiosin 25-C (PNU156804), [4-(4'-hydroxyphenyl)-amino-6,7-dimethoxyquinazoline] (WHI-P131 ), [4-(3'-bromo-4'-hydroxylphenyl)-amino-6,7-dimethoxyquinazoline] (WHI- P154), [4-(3',5'-dibromo-4'-hydroxylphenyl)-amino-6,7-dimethoxyquinazoline] WHI-P97,
• KRX-211 3- ⁇ (3R,4R)-4-methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidin- 1-yl ⁇ -3-oxo-propionitrile, in free form or in a pharmaceutically acceptable salt form, e.g. mono-citrate (also called CP-690,550), or a compound as disclosed in WO2004052359 or WO2005066156; - mediators, e.g. agonists or modulators of S1P receptor activity, e.g. FTY720 optionally phosphorylated or an analog thereof, e.g.
• a recombinant binding molecule having at least a portion of the extracellular domain of CTLA4 or a mutant thereof, e.g. an at least extracellular portion of CTLA4 or a mutant thereof joined to a non-CTLA4 protein sequence, e.g. CTLA4lg (for ex. designated ATCC 68629) or a mutant thereof, e.g. LEA29Y;
• - mediators e.g. inhibitors of adhesion molecule activities, e.g. LFA-1 antagonists, ICAM-1 or -3 antagonists, VCAM-4 antagonists or VLA-4 antagonists,
• - mediators e.g. inhibitors, of MIF activity
• - 5-aminosalicylate (5-ASA) agents such as sulfasalazine, Azulfidine®, Asacol®, Dipentum®, Pentasa®, Rowasa®, Canasa®, Colazal®, e.g. drugs containing mesalamine; e.g mesalazine in combination with heparin;
• - mediators e.g. inhibitors, of TNF-alpha activity, e.g. including antibodies which bind to TNF-alpha, e.g. infliximab (Remicade®), thalidomide, lenalidomide, - nitric oxide releasing non-steriodal anti-inlammatory drugs (NSAIDs), e.g. including COX- inhibiting NO-donating drugs (CINOD);
• CINOD COX- inhibiting NO-donating drugs
• mediators such as inhibitors of PDE4B activity
• mediators e.g. inhibitors, of caspase activity
• mediators e.g. agonists, of the G protein coupled receptor GPBAR1
• mediators e.g. inhibitors, of ceramide kinase activity
• MFAIDs multi-functional anti-inflammatory' drugs
• MFAIDs e.g. cytosolic phoshpholipase A2 (cPLA2) inhibitors, such as membrane-anchored phospholipase A2 inhibitors linked to glycosaminogiycans;
• antibiotics such as penicillins, cephalosporins, erythromycins, tetracyclines, sulfonamides, such as sulfadiazine, sulfisoxazole; sulfones, such as dapsone; pleuromutilins, fluoroquinolones, e.g. metronidazole, quinolones such as ciprofloxacin; levofloxacin; probiotics and commensal bacteria e.g. Lactobacillus, Lactobacillus reuteri;
• antiviral drugs such as ribivirin, vidarabine, acyclovir, ganciclovir, zanamivir, oseltamivir phosphate, famciclovir, atazanavir, amantadine, didanosine, efavirenz, foscarnet, indinavir, lamivudine, nelfinavir, ritonavir, saquinavir, stavudine, valacyclovir, valganciclovir, zidovudine.
• ribivirin such as ribivirin, vidarabine, acyclovir, ganciclovir, zanamivir, oseltamivir phosphate, famciclovir, atazanavir, amantadine, didanosine, efavirenz, foscarnet, indinavir, lamivudine, nelfinavir, ritonavir
• Anti-inflammatory drugs which are prone to be useful in combination with a compound of the present invention, either a TSC-compound or a NF1 -compound, e.g. prone to be useful according to the present invention, include e.g. non-steroidal antiinflammatory agents (NSAIDs) such as propionic acid derivatives (alminoprofen, benoxaprofen, bucloxic acid, carprofen, fenbufen, fenoprofen, fluprofen, flurbiprofen, ibuprofen, indoprofen, ketoprofen, miroprofen, naproxen, oxaprozin, pirprofen, pranoprofen, suprofen, tiaprofenic acid, and tioxaprofen), acetic acid derivatives (indomethacin, acemetacin, alclofenac, clidanac, diclofenac, fenclof
• Antiallergic drugs which are prone to be useful in combination with a compound of the present invention, either a TSC-compound or a NF1 -compound, e.g. prone to be useful according to the present invention, e.g. include antihistamines (H 1 -histamine antagonists), e.g.
• Anesthetics which are prone to be useful in combination with a compound of the present invention either a TSC-compound or a NF1 -compound, e.g. prone to be useful according to the present invention, e.g. include e.g.
• ethanol examples include ethanol, bupivacaine, chloroprocaine, levobupivacaine, lidocaine, mepivacaine, procaine, ropivacaine, tetracaine, desflurane, isoflurane, ketamine, propofol, sevoflurane, codeine, fentanyl, hydromorphone, marcaine, meperidine, methadone, morphine, oxycodone, remifentanil, sufentanil, butorphanol, nalbuphine, tramadol, benzocaine, dibucaine, ethyl chloride, xylocaine, and phenazopyridine.
• Antipruritics which are prone to be useful in combination with a compound of the present invention, either a TSC-compound or a NF1 -compound, e.g. prone to be useful according to the present invention, e.g. include include menthol, camphor, oatmeal baths, pramoxine, calamine lotion, doxepin, chlorpheniramine, cyproheptadine, e.g. in the form of a hydrochloride, sulphapyridine, aluminum acetate (aluminum acetate), hydroxyzine e.g.
• VISTARIL® fexofenadine
• TRK-820 fexofenadine
• terfenadine Burrow's solution
• Unna's boot tar emulsion.
• Astringent agents which are prone to be useful in combination with a compound of the present invention either a TSC-compound or a NF1 -compound, e.g. prone to be useful according to the present invention, e.g. include include alum, oatmeal, witch hazel, very cold water, and rubbing alcohol eg Surgical Spirit; astringent preparations include silver nitrate, zinc oxide, zinc sulfate, Burow's solution, tincture of benzoin, vegetable substances such as tannic and gallic acids.
• a pharmaceutical combination within the scope of this invention could include three active ingredients or more. Further, both the first agent and the co-agent are not the identical ingredient.
• the structure of the drug substances identified by code numbers, generic or trade names may be taken from the Internet, actual edition of the standard compendium "The Merck Index" or from databases, e.g., Patents International, e.g., IMS World Publications, or the publications mentioned above and below. The corresponding content thereof is hereby incorporated by reference.
• MEF cell lines are generated in which there is loss of either Tsc1 or Tsc2 and which have a profound decrease in signaling through Akt.
• Decreased Akt activation may be seen in response to all stimuli, including serum, PDGF, EGF, insulin, and IGF1.
• the basis for decreased signaling in response to PDGF is pursued, and it is found that levels of PDGFR ⁇ and PDGFR ⁇ are consistently decreased in Tsc1 or Tsc2 null cells, due to reduced transcription/translation.
• over-expression of PDGFR ⁇ by short or long-term transfection leads to increased Akt phosphorylation and stimulation in response to multiple growth factors.
• Tsc2 null or Tsc1 null cell lines leads to enhanced tumor growth in vivo in the subcutaneous tumor model, indicating that this down-regulation is critical in determining the relatively benign nature of tumors occurring in TSC patients. It may be also observed that signaling downstream of all of serum, PDGF, EGF, insulin, and IGF1 is also reduced in cells that are genetically engineered to lack both PDGFR ⁇ and PDGFR ⁇ , indicating cross-talk among these receptors.
• Tsc 1 or Tsc 2 null MEFs in response to IGF1 in combination with a Compound A may be explored.
• Wortmannin may be used as an IGF1 inibtor. Growth of Tsc1-/- and Tsc2-/- and control MEF cell lines in serum may be assessed in triplicate wells of cells plated at uniform density using the MTT assay. Growth responses are normalized individually for each cell line, to growth in the absence of any stimulation. It can be demonstrated that there is a robust growth response to serum by both Tsc1 null and the control cell lines, but there is little growth response of these cells to IGF1 stimulation and that Compound A significantly reduces growth under all conditions, and blocks any growth response of the cells to IGF1.
• Tsc1+/- mice are studied only.
• Tsc2+/- mice in which the use of the carcinogen ENU is performed to enhance and accelerate the rate of tumor formation in the kidney.
• Compound A has a dramatic effect in reducing kidney and liver tumors in Tsc1+/- mice and also in Tsc2+/- mice.
• Activity in neurofibromatosis may be determined in NF1 deficient cell or animals (mice) models, e.g. analogously to TSC deficient cell or animals (mice) models.
• Compound A shows activity in corresponding assays.

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